Sl.

No:
 Sl. No:
Technician Checklist Sl No 2
Name: IME NAME: Circle :
Date of Birth: Cluster:
Blood Group: Mobile No: District:
Road Parameters Other Safety Parameters
Sataus Available or Not ISI Mark Condition RAG Total COUNT OF HAZARDS IDENTIFIED IN LAST 3 MONTHS:
COUNT OF HAZARDS RECTIFIED:
Yes Yes Ok Red
DRIVING HELMET Count of unsafe pillars and gates (site count):.
No No Not Green count of unsfe pillars and gates removed (site count):.
Available or Not Date of Expiry RAG count of Vegetation issue sites :
DRIVING LICENSE Yes DD / MM/ YY Red
No Green count of Vegetation issue Pending :
MIRROR & LEG Guard Condition RAG Amber
VECHILE HAZARDS AT count of sites where PIU is bypassed Green
Available Ok Amber SITE
CONDITION Count of sites where PIU by pass is removed in last 3 months. ( Amber if any number is pending)
Not Available Not Green

Amber
Count of loose and uninsulated cables reported in last 3 months Green
DEFENSIVE Done Or Not Date of Training RAG
Count of Loose and unisulated cabes rectified (site count) ( If Number is greater than 0, then
DRIVING
amber)
TRAINING
Yes DD / MM/ YY Amber
Count of EB Junction box issues reported in last 3 months
No Green
Count of EB junciton box isues corrected in Last 3 months
Available or Not Condition RAG
REFLECTIVE Amber
Available Ok Amber
JACKET NO OF PTW AUTHORIZATION THROUGH I-MAP for Indus Partners in 3 months:
Not Available Not Green PTW(PERMI NO OF PTW AUTHORIZATION NOT THROUGH I-MAP-Indus Partners in 3 months: Green

Condition of the Ok Amber T TO WORK) Count of PTW authorised for Acti ve Partners in 3 months: (If no PTW Authorized, then amber)
PTW auto authorize:
Tyre Not Green
COUNT OF VISITs IN LAST 3 MONTHS:…………………………………………………………………………………………..........
SUPPORT REQUIRED TO AVIOD NIGHT VISIT (Y/N): Yes No Quality of Count of sites Done : Done Not
NIGHT VISIT
CM TT RAISED (Y/N) : Yes No PM Count of sites PM quality is rejected
AGEING OF CM TT :……………………………………………................................................................................

RAG Status Road : Red Green Amber RAG Status Other : Red Green Amber
Electrical Parameters Behavioural Parameters
Status Available or Not Insulation No of Tools Available RAG Status MOD 0 1 MOD 2 RAG
Red
Yes Yes Green
Available Ok Amber TRAINING
TOOLS Count No No Amber
Not Available Not Green STATUS
Date ………/……/………. Date ………/……/………. (if both completed-Green
if only MOD 0 is completed-Amber
if MOD 0 is not completed-Red
Available or Not Certified ( Honeywell) RAG ITI Done or not Electrical (yes /No) RAG
Education Amber
ELECTRICAL
Available Using Red Qualifciatioo Yes Yes
HAND GLOVES Green
Not Available Not Using Green n No No
if all compliant then Green else Amber
Available or Not Certified / Approved make RAG Amber
Count of safety violaiton reported in 3 months :
ELECTRICAL Incident (If near miss count is 0
Available Using Red Count of FA & LTI reported in 3 months :
SAFETY SHOES Reporting Amber)
Not Available Not Using Green Count of Near miss reported in 3 months :

Total sites under the technician :…………………………………………………………………………………………………………. SAFETY Amber

Automation and Count of sites in Automation :……………………………………………………………………………………………………………… TRAINING NO OF SAFETY TRAINING ATTENDED : Green
Alarm Gree sites: ……………………………………………………………………………………………………………………………………………. for last 3 NO OF SAFETY TALK ATTENDED: If No Safety Talk Attended then
Site count under sequential Alarms:…............................................................................................. months Amber

RAG Status Road : Red Green Amber RAG Status Road : Red Green Amber

Overall Technician RAG Status: RED GREEN AMBER

I ( Technician Name)……………………………………...………………………… S/o………………………………………………………hereby declare that I will use helmet, Safety shoes,Safety gloves and other
proctection equipment while on duty at sites belonging to Indus Towers Ltd. I further declare and confirm that I will not do any un-authorised electrical or other work on sites and also
ensure that i will do PTWonline Authorization at site. I will always follow SHUBHAM rules-Wear Seat belt in Four Wheeler, useing Helmet while driving two wheeler, no Unsauthorised
electrical work, use of Body Harness during height work, no Alcohol while working at site/driving, will never use Mobile while driving.

Technician Signature NTTF Signature